Romano Simone, Kitkungvan Danai, Nguyen Duc T, El-Tallawi Carlos, Graviss Edward A, Farzaneh-Far Afshin, Shah Dipan J
Department of Medicine, Section of Internal Medicine C, University of Verona, Verona, Italy.
Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA.
Eur Heart J Cardiovasc Imaging. 2024 Dec 31;26(1):126-134. doi: 10.1093/ehjci/jeae245.
Chronic primary mitral regurgitation (MR) results in progressive left ventricular (LV) remodelling. Abnormal myocardial deformation (strain) can be present despite preserved ejection fraction (EF). Cardiovascular magnetic resonance (CMR) feature-tracking techniques allow assessment of global longitudinal strain (GLS) from routine cine images. The aim of this study is to evaluate the prognostic value of CMR feature tracking-derived GLS in patients with primary MR.
Consecutive patients undergoing CMR for chronic MR from January 2012 to June 2018 were enrolled. Patients with LVEF <50% were excluded. The composite primary outcome aiming to detect decompensation related to MR comprised (i) referral for mitral surgery owing to symptoms or LV systolic dysfunction or (ii) cardiovascular death. The secondary outcome was all-cause death. A total of 422 patients were followed for a median of 2.7 years, and the primary endpoint was met in 93 patients (34 patients reported symptoms at baseline). At multivariable analysis, GLS≥ -16.6% was associated with primary outcome [hazard ratio (HR) 1.90, P = 0.01]. In moderate MR cohort, patients with GLS≥ -16.6% had worse event-free survival, whereas there was no significant difference in mild or severe MR groups. GLS≥ -16.0% remained associated with all-cause death after adjusting for other covariates including the MR severity (HR 2.24, P = 0.02).
In patients with primary MR with preserved systolic function, GLS was associated with our composite outcomes and all-cause death. GLS may serve as a marker of cardiac dysfunction in the patients with primary MR with preserved systolic function allowing identification of patients likely to decompensate during observation.
慢性原发性二尖瓣反流（MR）会导致左心室（LV）进行性重塑。尽管射血分数（EF）保留，但仍可能存在心肌变形异常（应变）。心血管磁共振（CMR）特征追踪技术可从常规电影图像评估整体纵向应变（GLS）。本研究的目的是评估CMR特征追踪得出的GLS在原发性MR患者中的预后价值。
纳入2012年1月至2018年6月因慢性MR接受CMR检查的连续患者。排除左心室射血分数（LVEF）<50%的患者。旨在检测与MR相关失代偿的复合主要结局包括：（i）因症状或左心室收缩功能障碍而转诊进行二尖瓣手术或（ii）心血管死亡。次要结局是全因死亡。共对422例患者进行了中位2.7年的随访，93例患者达到主要终点（34例患者在基线时报告有症状）。在多变量分析中，GLS≥ -16.6%与主要结局相关[风险比（HR）1.90，P = 0.01]。在中度MR队列中，GLS≥ -16.6%的患者无事件生存期较差，而在轻度或重度MR组中无显著差异。在调整包括MR严重程度在内的其他协变量后，GLS≥ -16.0%仍与全因死亡相关（HR 2.24，P = 0.02）。
在收缩功能保留的原发性MR患者中，GLS与我们的复合结局和全因死亡相关。GLS可作为收缩功能保留的原发性MR患者心脏功能障碍的标志物，有助于识别观察期间可能失代偿的患者。
